New York Times Examines Eli Lilly Program Aimed At Reducing Unnecessary Medicaid Prescriptions For Antipsychotic Drug Zyprexa

The New York Times on Friday examined an Eli Lilly program that offers state Medicaid programs assistance in monitoring physicians' prescribing practices for Zyprexa, a treatment for schizophrenia and bipolar disorder that is the single largest drug cost in state Medicaid budgets. Under the program, which Lilly has implemented in two dozen states since 2003, the company pays New York-based Comprehensive NeuroScience an undisclosed amount to monitor physicians' prescribing practices. When physicians prescribe doses that are too high or treat patients with too many similar drugs, "Dear Doctor" letters are sent notifying them that their prescribing patterns are outside of normal practices. Compliance is voluntary. Physicians also are notified if patients are not renewing their prescriptions. While Medicaid administrators in Michigan, Missouri and some other states say that the program has saved them money, others criticize Lilly for offering the program only in exchange for certain concessions. For example, Medicaid officials in at least four states say that Lilly offered them the program as an alternative to placing Zyprexa on a restricted-drug list. Lilly spokesperson Janice Chavers said that the program is not operating in any state where Zyprexa's use is restricted, although the company says that it generally does not require unrestricted access to operate the program. Lilly "acknowledges that it decided to finance the programs in response to state efforts to cut costs" through the use of preferred-drug lists and other measures, the Times reports. Lilly says it opposes restricted access to mental health drugs because physicians need the ability to prescribe any appropriate drug for serious mental illness.

Other Experiences with Program
David Beshara, chief pharmacy officer for Tennessee's Medicaid program, said that his state declined Lilly's offer to implement the program in exchange for placing Zyprexa on its preferred-drug list. Beshara said the offer was rejected because the potential savings were uncertain and because the program was offered on the basis that the state would not receive rebates for placing the drug on its preferred list, as is common industry practice. James Hardy, former deputy secretary for medical assistance in Pennsylvania, said that his state also declined Lilly's offer to provide the program in lieu of rebates. Hardy said, "I didn't like that commingling of service and rebates," adding, "I want to manage the benefit, and I want to get the best rebate deal I can." However, Joseph Parks, medical director of the Missouri Department of Mental Health, said, "I think they are honestly trying to improve their image by doing the right thing and by doing something about inappropriate overutilization." Parks has served as a paid consultant to Comprehensive NeuroScience (Saul, New York Times, 3/23).

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